The 16 th Annual Pain Management Symposium Caesar s Palace, Las Vegas, Nevada. Disability Assessment 6:00 PM Tuesday, February 19, 2014.

Transcription

1 The 16 th Annual Pain Management Symposium Caesar s Palace, Las Vegas, Nevada Disability Assessment 6:00 PM Tuesday, February 19, 2014 Daniel J. Leizman, MD Physical Medicine & Rehabilitation Staff, Pain Management Department Cleveland Clinic Assistant Professor of Anesthesiology Cleveland Clinic Lerner College of Medicine Introduction 1. Disability Assessment 2. Definitions 3. Agencies/Entities 4. AMA Guides to Impairment 5 th Edition, and 6 th Edition 5. Services to Provide 6. Operational Issues for Providing Services 7. Summary and Discussion 8. References

2 Disability Assessment 1. Different than patient care, involves legal system, compensation, dispute 2. Adversarial 3. Legal documents, opinions, always assume under oath 4. Compensation for expertise and time, not opinion 5. Assessing employability is difficult and imperfect Definitions 1. Pathology a disease or trauma that causes changes in structure or function of a specific body tissue or organ 2. Impairment occurs at the organ system level and is defined as a loss or abnormality of psychological, physiologic, or anatomic structure or function resulting from pathology 3. Disability occurs at the personal level and is defined as any restriction or lack (resulting from impairment) of ability to perform an activity in the manner or within the range considered normal for a human being 4. Handicap occurs at the societal level and is defined as a disadvantage for a given individual that limits or prevents fulfillment of a role that is normal (depending on age, gender, social, and cultural factors) for that individual (World Health Organization definitions)

3 Definitions (continued) 5. Medical Legal Report 6. IME Independent Medical Examination 7. Impairment Rating 8. Temporary, Permanent 9. Maximum Medical Improvement (MMI) a. Cannot perform impairment rating until individual is MMI Definitions (continued) 10. FCE Functional Capacity Evaluation a. Typically 2 5 hours b. Performed by PT or OT c. Proprietary protocols 11. PCE Physical Capacity Evaluation a. Completed by physician evaluator 12. Job Description

4 Agencies/Entities 1. Workers Compensation a. State System i. State by State basis ii. First State was Wisconsin in 1911 iii. No fault, and the employer assumes liability for all claims arising as a result of injury or illness directly attributable to the workplace iv. Causality must be established v. Claim must be filed within specified time period vi. Benefits covered include medical and rehabilitation expenses, and wage loss benefits Agencies/Entities (continued) 1. Workers Compensation b. Federal Employees Compensation Act i. Federal civilians ii. Post Office workers iii. Peace Corp workers c. Federal Employers Liability Act and Jones Act i. Interstate railroad industry d. Federal Black Lung Program i. Coal miners e. Self Insured Companies

5 Agencies/Entities (continued) 2. Department of Veterans Affairs 3. Social Security Disability a. established in Disability Insurance Companies a. 40 million Americans have private long term disability coverage 5. Employers Agencies/Entities (continued) 6. Attorneys, Personal Injury a. Tort Claims i. A legal duty existed ii. A breach of legal duty occurred iii. Harm or injury occurred as the direct result b. Reasonable degree of possibility, probability, and certainty c. Plaintiff Counsel d. Defense Counsel

6 Agencies/Entities (continued) AMA Guides to Impairment 1. 1 st Edition was in th Edition was in th Edition was Objective findings and subjective findings 5. Issue of pain not being an objective finding 6. Range of Motion (ROM) model, and Diagnosis Related Estimates (DRE)model 7. Combining limb parts; adding upper limb, lower limb, and spine; whole body impairment rating

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8 Services to Provide 1. Work Opinion a. Job description, work restriction, job accommodation b. ADA mandates reasonable accommodation without undue hardship or direct threat to health and safety of disabled worker or any coworkers. c. PCE vs. FCE d. U.S. Department of Labor Work Classification Services to Provide (continued) 2. Medical Legal Reports 3. Impairment Ratings

9 Services to Provide (continued) 4. Independent Medical Evaluation, IME Components a. Diagnosis and Severity b. Causality c. Necessity of Treatment d. Additional Testing e. MMI f. Impairment Rating g. Return to Work Restriction, including temporary and permanent restrictions Services to Provide (continued) 5. Depositions

10 Operational Issues for Providing Services 1. Rendering Opinions 2. Medical Report Preparation 3. Form Completion 4. Depositions 5. Customer Service 6. Fees 7. Record Keeping PCE Form

11 Summary 1. Fairness 2. Objectivity 3. Consistency 4. Functionally Oriented Evaluation Discussion

12 References American Medical Association Braddom, Randall L., ed. Physical Medicine & Rehabilitation. 3rd ed. (pp ). Philadelphia, PA: Saunders Elsevier, DeLisa, Joel A., ed. Physical Medicine & Rehabilitation Principles and Practice. 4th ed. Vol. 1. (pp ). Philadelphia, PA: Lippincott Williams & Wilkins, 2005.